Major findings from the Canadian incidence study of reported child abuse and neglect

OBJECTIVE: To present key findings from the Canadian Incidence Study of Reported Child Maltreatment (CIS) in sufficient detail to provide a basis for international comparisons in terms of forms and severity of maltreatment and the age and sex of victims. METHOD: A survey conducted in a random sample of 51 child welfare service areas across Canada tracked child maltreatment investigations conducted during the months of October to December 1998, produced a national sample of 7672 child maltreatment investigations. Information was collected directly from investigating workers on child and family background, perpetrator characteristics, severity and types of maltreatment and service and court outcomes of investigations. RESULTS: Forty-five percent of investigations were substantiated and in a further 22% of investigations maltreatment remained suspected. Primary reasons for investigation were physical abuse (31%), sexual abuse (11%), neglect (40%), and emotional maltreatment (19%). A larger proportion of physical abuse cases are isolated incidents involving older children and are more likely to lead to injuries. Sexual abuse, neglect and emotional maltreatment involve more chronic situations with children showing signs of emotional harm. Rates of investigated and substantiated maltreatment are lower in Canada compared to the United States, but are higher than rates reported in Australia. CONCLUSIONS: The CIS provides much needed information for developing a better understanding of the profile and needs of children and families investigated by child welfare authorities in Canada. The study also serves as a point from which international comparisons can be made.     

The protective effect of neighborhood social cohesion in child abuse and neglect

Relations between parents within a neighborhood have the potential to provide a supportive environment for healthy and positive parenting. Neighborhood social cohesion, or the mutual trust and support among neighbors, is one process through which parenting may be improved. The current study investigates the association between neighborhood social cohesion and abuse and neglect, as well as specific types of abuse and neglect. The sample for the study is comprised of 896 parents in one urban Midwestern County in the United States. Participants were recruited from Women, Infants, and Children clinics. Negative binomial regression is used to examine the association between neighborhood social cohesion and child maltreatment behaviors, as measured by the Conflict Tactics Scale, Parent-to-Child Version (Straus et al., 1998). In this sample of families, neighborhood social cohesion is associated with child neglect, but not abuse. In examining the relationship with specific types of abuse and neglect, it was found that neighborhood social cohesion may have a protective role in some acts of neglect, such as meeting a child's basic needs, but not potentially more complex needs like parental substance abuse.     

Neighborhood alcohol outlet density and rates of child abuse and neglect: Moderating effects of access to substance abuse services

This study investigates the relationship between concentrations of on- and off-premises alcohol outlets and rates of child abuse and neglect. Additionally, the study seeks to locate protective features of a neighborhood's built environment by investigating the potentially moderating role that access to substance abuse treatment and prevention services plays in the relationship between alcohol outlet density and child maltreatment. Using a cross-sectional design, this ecological study utilized data from 163 census tracts in Bergen County, New Jersey, on reports of child abuse and neglect, alcohol outlets, substance abuse treatment and prevention facilities, and the United States Census to investigate the linkages between socioeconomic structure, alcohol availability, and access to substance abuse service facilities on rates of child abuse and neglect. Findings indicate areas with a greater concentration of on-premises alcohol outlets (i.e., bars) had higher rates of child neglect, and those with easier access to substance abuse services had lower rates of neglect, controlling for neighborhood demographic and socioeconomic structure. Additionally, the relationship between on-premises alcohol outlet density and rates of child neglect was moderated by the presence of substance abuse service facilities. A greater concentration of off-premises outlets (i.e., liquor stores) was associated with lower rates of physical abuse. Findings suggest that the built environment and socioeconomic structure of neighborhoods have important consequences for child well-being. The implications for future research on the structural features of neighborhoods that are associated with child well-being are discussed.     

Examining the effectiveness of home-based parent aide services to reduce risk for physical child abuse and neglect: Six-month findings from a randomized clinical trial

Objective

This study set out to carry out a feasible, real-world, randomized clinical trial to examine the benefits of home-based paraprofessional parent aide services in reducing physical abuse and neglect risk in high-risk parents.

Methods

Families were randomly assigned to receive either parent aide plus case management services (n = 73) or case management services only (n = 65), collecting in-home data on physical child abuse and neglect and proximal risk and protective factors, just prior to service initiation, and again after six months of services.

Results

Mothers receiving parent aide and case management services reported significant improvements from baseline to six-month follow-up in self-reported indicators of physical child abuse risk, as well as improvements on parental stress, mastery, depression, and anxiety, whereas mothers receiving only case management services did not. The slopes of such observed changes across groups, however, were not found to be statistically significantly different. No discernable improvements were found with regard to indicators of risk for child neglect.

Conclusions

As the first randomized clinical trial examining the effectiveness of parent aide services, this study provides the first controlled evidence examining the potential benefits of this service modality. This study suggests promising trends regarding the benefit of parent aide services with respect to physical child abuse risk reduction and related predictors, but evidence does not appear to suggest that such services, as they are presently delivered, reduce child neglect.

Practice implications

These findings support the continued use of parent aide services in cases of physical child abuse and also suggest careful consideration of the ways such services may be better configured to extend their impact, particularly with respect to child neglect risk.     

Removing the child--prosecuting the offender in cases of sexual abuse: evidence from the national reporting system for child abuse and neglect

Sexual abuse has come to public attention so rapidly and is such a difficult problem to deal with that many observers are concerned that the quality of child protective intervention in these cases has been haphazard and indiscriminate. This article analyzes data on all 6,096 cases of child sexual abuse which were "officially reported" in 1978 to see what kinds of intervention were made. The data show that foster placement occurred in more cases of sexual abuse than physical abuse, and was concentrated among cases of older children who reported their own victimization. Criminal action was taken almost five times more often in cases of sexual abuse than in cases of physical abuse, and occurred more often among cases which were directly reported to police and involved offenders with prior criminal records. Black families and poorer families did not seem to be the objects of obvious discrimination in the disposition of these cases.     

The prevention of child abuse and neglect: A review of the literature with recommendations for application

Families at high risk for inadequate parenting can be identified during the perinatal period, or during later health care visits. Effective intervention can be implemented for these special families. During the maternity ward stay, intervention can include early delivery room contact, rooming-in arrangements, and increased teaching sessions on child care. The primary physician can provide frequent office visits, telephone contacts and helpful advice during acute illnesses and developmental phases which might precipitate child abuse. The physician can seek assistance from outreach workers such as public health nurses, lay health visitors, and child welfare caseworkers. Community prevention programs such as parenting classes, Parent's Anonymous groups, crisis nurseries and crisis hotlines should also be integrated into the family's treatment. When provided in concert, these actions can stabilize most dysfunctional families.     

Influence of the referral process by a child protective agency on the outcome of psychiatric-psychological assessments of child abuse/neglect cases

Many Child Protective agencies in the United States have guidelines for referring certain kinds of abuse/neglect cases for psychiatric-psychological assessments which leave up to the referring agent such decisions as: choice of assessor (psychiatrist, psychologist, other), purpose of evaluation, and part of the family system to be evaluated. In order to develop a more systematic approach to comprehensive evaluations of abusive families, the referral process from the Hawaii Child Protective Services Agency to a child guidance center was analyzed through chart review, and its influence on the outcome of psychiatric-psychological assessments was examined. Evaluations by psychiatrists were also compared with those of psychologists. The results showed that the great majority of the cases referred for assessment were victim-children and that recommendations paralleled this trend by being child rather than adult or family oriented. In addition, referral questions and resulting recommendations centered more on diagnosis than on issues of intervention (treatment, placement, legal needs), suggesting an underutilization of the assessors' clinical skills. Differences between psychiatrists and psychologists are also reported. These findings point to a need for greater commitment to family pathology. Implications for developing more effective referral guidelines and for training are discussed.     

Exposure to domestic violence as abuse and neglect: Constructions of child maltreatment in daily practice

Research finds that exposure to domestic violence can adversely affect the emotional, behavioral, and physical health of children. These effects have led some child advocates and policymakers in the United States to conclude that child exposure to domestic violence (CEDV) is a type of child maltreatment warranting state intervention. However, few states have defined CEDV as a type of maltreatment in statute and little is known about how child welfare agencies respond to allegations of CEDV in the absence of other safety threats. This study considers that CEDV itself might prompt an initial child welfare referral and may be construed by workers as a type of statutory maltreatment. Using a random sample (n = 295) of case records, this study analyzed one large child welfare agency’s response to referrals alleging CEDV between 2011 and 2012. Findings indicate that CEDV itself did trigger investigation. At time of referral, workers used statutory maltreatment typologies to construe alleged CEDV as a type of maltreatment; however, CEDV was not consistently construed as a safety threat and few allegations were substantiated. Instead most families were referred to community-based domestic violence services. Findings indicate that CEDV was not consistently construed as a type of statutory maltreatment and infrequently resulted in ongoing child welfare services. Findings suggest that training is needed to help workers better assess CEDV-related safety threats. Findings also raise questions about what types of interventions are needed to protect children from domestic violence and which types of agencies are best positioned to deliver those interventions.     

Reported contact with child protection services among those reporting child physical and sexual abuse: results from a community survey

OBJECTIVE: This study uses results from a large community survey to examine the relationship between a history of child maltreatment and self-reports of contact with Child Protection Services (CPS). METHODS: The Ontario Health Supplement was a province-wide, probability-based survey of household dwellings in the province of Ontario, Canada. A random sample of residents aged 15 and older participated in the Ontario Health Supplement (N=9953). A face-to-face interview included a question about contact with Child Protection Services (CPS), and the Child Maltreatment History Self-Report, a self-administered questionnaire, was used to assess history of child physical and sexual abuse. RESULTS: Only a very small percentage of respondents with a history of child abuse reported contact with CPS; 5.1% of those with a history of physical abuse, and 8.7% of those with a history of sexual abuse. Contact with CPS was associated with younger age of respondent for both types of abuse and female gender for physical abuse. In the case of sexual abuse, younger respondents whose parental employment classification was in the lower socioeconomic group were more likely to have contact with CPS. CONCLUSIONS: Interventions that target only those who come in contact with CPS will not reach most persons exposed to child abuse.     

A community development approach to the prevention of institutional and societal child maltreatment

The Community/Institutional Development (CID) system addresses the needs of children placed in out-of-home care facilities. The major purpose of the system is to prevent the occurrence of institutional and societal child maltreatment. It features community/institutional collaboration in the review of institutionalized children's care, and the development of programs to prevent child maltreatment. This would represent a genuine collaboration between institutions and their communities, assessing the contributions of both to the quality of child care. At this time the CID system is a pilot project in the state of Kansas. There are a total of eight public and private child care institutions involved. The project is endorsed by the Office of the Governor, the Department of Social and Rehabilitation Services and the Kansas Chapter of the National Committee for the Prevention of Child Abuse. Preliminary impressions indicate that the CID concept is practical, feasible and cost effective. It could also be adapted to the needs of other age groups. The concept is outlined.     

Cues of paternal uncertainty and father to child physical abuse as reported by mothers in Rio de Janeiro, Brazil

Objective

Paternity is uncertain, so if paternal feelings evolved to promote fitness, we might expect them to vary in response to variables indicative of paternity probability. We therefore hypothesized that the risk of lapses of paternal affection, including abusive assaults on children, will be exacerbated by cues of non-paternity.

Methods

Cross-sectional study of 331 Brazilian mothers, interviewed about 1 focal child (age 1–12) residing with her and the putative father. Child physical abuse was assessed using the Conflict Tactic Scales: Parent Child (CTSPC). Two potential cues of (non) paternity were (1) whether the parents co-resided when the child was conceived, and (2) whether third parties allegedly commented on father–child resemblance. Data were analyzed through multiple logistic regressions.

Results

Mothers reported child physical abuse by 15.9% (95% CI 4.6–27.1) of fathers who had not cohabited with them at conception, compared to 5.9% (95% CI 3.1–8.7) of those who had. The odds ratio for abuse by fathers who had not cohabited at conception in relation to those who had—adjusted for income, education, age, sex of child, whether child was first born, household size, time father spent with child, and alcohol abuse and drug use by father—was 4.3 (95% CI 1.4–13.8). Mothers reported abuse of 7.0% (95% CI 4.0–10.0) of children who purportedly resembled their fathers, versus 8.7% (95% CI 0.2–17.1) of those who did not.

Conclusion

According to maternal reports, not having co-resided at conception quadrupled the chance of child physical abuse by currently co-residing Brazilian fathers. The reported prevalence of abuse was unrelated to reported allegations of father–child resemblance.     

The overrepresentation of First Nations children and families involved with child welfare: Findings from the Ontario incidence study of reported child abuse and neglect 2013

BackgroundWhile there are national studies on the overrepresentation of First Nations children in the Canadian child protection system, there is a dearth of provincial/territorial studies.ObjectiveThe objectives are to: 1) estimate the rate of overrepresentation of First Nations children and youth involved in child welfare investigations in the Ontario child welfare system and, 2) determine which factors drive the overrepresentation of First Nations children in child welfare at the investigation stage compared to White children.Participants and SettingChild welfare workers completed a three-page data collection form at the conclusion of a child protection investigation.MethodsA secondary analysis of the Ontario Incidence Study 2013 was conducted. Incidence rates were calculated and bivariate analyses were conducted, comparing investigations involving First Nations children to investigations involving White children.ResultsFirst Nations children represent 2.5% of the child population; however, they represent 7.4% of child maltreatment related investigations in Ontario. The rate of investigations for First Nations children was approximately three times higher than the rate for White children. Overrepresentation was most pronounced for investigations of neglect and exposure to intimate partner violence. Rates of substantiation, ongoing child welfare services, child welfare court, and placement in care were higher for the First Nations child population.ConclusionsThe findings provide a foundation for further research and analyses examining the compounding of disparities across the investigation process. Research is needed to disentangle factors that influence decision-making in the child welfare system and how these vary based on a child’s race.     

Gendered pathways from child sexual abuse to sexual aggression victimization and perpetration in adolescence and young adulthood

This study aimed to examine the pathways from child sexual abuse to sexual assault victimization and perpetration in adolescence and early adulthood, considering risky sexual behavior and lowered sexual self-esteem as mediator variables. In a two-wave longitudinal study with 2251 college students in Germany, male and female participants provided reports of sexual aggression victimization and perpetration since age 14 (T1) and again a year later (T2), covering the last 12 months. In addition, child sexual abuse (CSA; before the age of 14), risky sexual behavior, and sexual self-esteem were assessed at T1, and risky sexual behavior and sexual-self-esteem were assessed again at T2. Experience of CSA was significantly associated with greater likelihood of sexual aggression victimization and perpetration, lower sexual self-esteem, and more risky sexual behavior in both gender groups at T1 and was directly related to victimization at T2 among male participants. In both gender groups, CSA indirectly contributed to a higher probability of sexual victimization at T2 via its impact on victimization T1. In males, the indirect path from CSA to T2 perpetration via T1 perpetration was also significant. Through its negative impact on sexual self-esteem, CSA indirectly increased the probability of sexual victimization among women and the probability of sexual aggression perpetration among men. Risky sexual behavior mediated the pathway from CSA to sexual victimization at T2 for men and women and the pathway from CSA to sexual aggression perpetration for women. The findings contribute to the understanding of gendered effects of CSA on revictimization and the victim-to-perpetrator cycle.     

Longitudinal examination of peer and partner influences on gender-specific pathways from child abuse to adult crime

Research provides increasing evidence of the association of child abuse with adult antisocial behavior. However, less is known about the developmental pathways that underlie this association. Building on the life course model of antisocial behavior, the present study examined possible developmental pathways linking various forms of child abuse (physical, emotional, sexual) to adult antisocial behavior. These pathways include child and adolescent antisocial behavior, as well as adulthood measures of partner risk taking, warmth, and antisocial peer influences. Data are from the Lehigh Longitudinal Study, a prospective longitudinal study examining long-term developmental outcomes subsequent to child maltreatment. Participant families in the Lehigh Longitudinal Study were followed from preschool age into adulthood. Analyses of gender differences addressed the consistency of path coefficients across genders. Results for 297 adult participants followed from early childhood showed that, for both genders, physical and emotional child abuse predicted adult crime indirectly through child and adolescent antisocial behavior, as well as adult partner and antisocial peer influences. However, for females, having an antisocial partner predicted an affiliation with antisocial peers, and that in turn predicted adult crime. For males, having an antisocial partner was associated with less partner warmth, which in turn predicted an affiliation with antisocial peers, itself a proximal predictor of adult crime. Sexual abuse also predicted adolescent antisocial behavior, but only for males, supporting what some have called “a delayed-onset pathway” for females, whereby the exposure to early risks produce much later developmental outcomes.     

The characteristics of reports to the police of child sexual abuse and the likelihood of cases proceeding to prosecution after delays in reporting

Delays in disclosing and reporting child sexual abuse to the police are common, particularly among males and those who have been abused by clergy and others in a position of trust. This study, commissioned by the Royal Commission into Institutional Responses to Child Sexual Abuse, examined the patterns of timely and delayed reporting of sexual offences against children, and the likelihood of legal action commencing. De-identified unit record data for all sexual offences against children reported to the police over 20 years were obtained from official crime statistics agencies in two Australian states. While there were similarities between the two states in terms of the influence of public inquiries on reporting numbers over this period, and in the factors associated with delayed reporting, there were substantial differences in the likelihood of legal action being taken in cases reported by a child or adult complainants. In one state, legal action was more likely with increasing delay, until the delays extended to 10–20 years, after which the likelihood of legal action decreased. In the other state, the pattern was quite different – reports of sexual assault were somewhat more likely to result in legal action with immediate reporting. The least likely to proceed were cases involving young children in more recent years; long delays into adulthood were not necessarily adverse for prosecution.     

The "geography" of child maltreatment in Israel: Findings from a national data set of cases reported to the social services

OBJECTIVES: This article examines the "geography" of reported cases of child maltreatment in Israel by determining its frequency and rates according to nationality, area of residence, and size and type of locality. METHOD: The study collected data at the local level in Israel based on reports to social services of cases of child maltreatment during 2000; locality is the unit of analysis. RESULTS: The rate of reported cases of child maltreatment was 17.8 per 1,000 children in Israel in 2000. The rates varied, however, among different localities. They were lower in Arab localities (9 per 1,000 children) than in the Jewish ones (20 per 1,000), higher in large cities and other socioeconomic affluent localities (19 per 1,000), and varied according to the geographic area. CONCLUSIONS: This study demonstrates considerable variation in rates of reported cases of child maltreatment by locality and by population makeup. Thus, to fulfill the Israeli legislation of mandatory reporting of any reasonable suspicion of child maltreatment, the state should better develop policies and services that encourage reporting of child maltreatment among the Arab and ultraorthodox populations and in smaller or socioeconomic disadvantaged localities. Furthermore, the social services must build a bridge to the minority populations in Israel, developing their trust in these services and increasing their propensity to use them.     

Facilitators and barriers to the successful implementation of a protocol to detect child abuse based on parental characteristics

To determine the critical facilitating and impeding factors underlying successful implementation of a method to detect child abuse based on parental rather than child characteristics known as the Hague Protocol. The original implementation region of the protocol (The Hague) was compared to a new implementation region (Friesland), using analysis of referrals, focus group interviews (n = 6) at the Emergency departments (ED) and at the Reporting Centers for Child abuse and Neglect (RCCAN) as well as questionnaires (n = 76) at the EDs. Implementation of the Hague Protocol substantially increased the number of referrals to the RCCAN in both regions. In Friesland, the new implementation region, the number of referrals increased from 2 out of 92,464 patients (three per 100,000) to 108 out of 167,037 patients (62 per 100,000). However in Friesland, child abuse was confirmed in a substantially lower percentage of cases relative to the initial implementation region (62% vs. 91%, respectively). Follow-up analyses suggest that this lower positive predictive value may be due to the lack of training for RCCAN professionals concerning the Hague Protocol. The focus group interviews and questionnaires point to time limitations as the main impediment for implementation, whereas an implementation coach has been mentioned as the most important facilitating factor for success. The Hague Protocol can be used to detect child abuse beyond the initial implementation region. However, training is essential in order to assure a consistent evaluation by the RCCAN.     

Associations between childhood deaths and adverse childhood experiences: An audit of data from a child death overview panel

BackgroundDespite strong associations between adverse childhood experiences (ACEs) and poor health, few studies have examined the cumulative impact of ACEs on causes of childhood mortality.MethodsThis study explored if data routinely collected by child death overview panels (CDOPs) could be used to measure ACE exposure and examined associations between ACEs and child death categories. Data covering four years (2012–2016) of cases from a CDOP in North West England were examined.ResultsOf 489 cases, 20% were identified as having ≥4 ACEs. Deaths of children with ≥4 ACEs were 22.26 (5.72–86.59) times more likely (than those with 0 ACEs) to be classified as ‘avoidable and non-natural’ causes (e.g., injury, abuse, suicide; compared with ‘genetic and medical conditions’). Such children were also 3.44 (1.75–6.73) times more likely to have their deaths classified as ‘chronic and acute conditions’.ConclusionsThis study evidences that a history of ACEs can be compiled from CDOP records. Measurements of ACE prevalence in retrospective studies will miss individuals who died in childhood and may underestimate the impacts of ACEs on lifetime health. Strong associations between ACEs and deaths from ‘chronic and acute conditions’ suggest that ACEs may be important factors in child deaths in addition to those classified as ‘avoidable and non-natural’. Results add to an already compelling case for ACE prevention in the general population and families affected by child health problems. Broader use of routinely collected child death records could play an important role in improving multi-agency awareness of ACEs and their negative health and mortality risks as well in the development of ACE informed responses.